Precision Medicine in Heart Failure: Integrating Ventricular-Vascular Interaction and Arterial Stiffness into Patient Phenotyping.

A key limitation in contemporary HF management is the marked heterogeneity of the syndrome, driven by diverse pathophysiological mechanisms that are not fully captured by traditional classifications based on left ventricular ejection fraction. Precision medicine has emerged as a promising approach to address this heterogeneity by integrating clinical characteristics, circulating biomarkers, advanced imaging, and computational phenotyping strategies. However, current frameworks predominantly emphasize myocardial dysfunction, while the contribution of vascular abnormalities remains underrepresented. The interaction between the left ventricle and the arterial system plays a fundamental role in cardiovascular performance. Arterial stiffness, commonly assessed by pulse wave velocity (PWV), represents a key determinant of vascular aging and a robust predictor of cardiovascular risk. Increasing evidence suggests that vascular dysfunction contributes significantly to the pathophysiology and clinical expression of HF, particularly in phenotypes characterized by preserved ejection fraction. This review synthesizes current evidence on precision medicine in HF and highlights the emerging role of arterial stiffness and PWV in multidimensional patient phenotyping. We propose that integrating vascular parameters into existing phenotyping frameworks may enhance risk stratification, improve mechanistic understanding, and support the development of more personalized therapeutic strategies in heart failure. Unlike previous reviews that have addressed arterial stiffness or heart failure phenotyping separately, this work uniquely integrates ventricular-vascular interaction and pulse wave velocity into a comprehensive precision medicine framework for heart failure. By bridging vascular physiology with data-driven phenotyping strategies, this review provides a novel conceptual model for incorporating arterial stiffness into multidimensional patient characterization across the full spectrum of heart failure phenotypes.